| NPI | 1770888588 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: WA CH60647239) |
| Additional Taxonomies | 111NR0400X (Licence: WA CH60647239) |
| 111NS0005X Chiropractor, Sports Physician (Licence: NY X012149-1) | |
| Enumeration Date | 2011-01-26 |
| Last Update Date | 2021-10-15 |